CAGUAS, P.R. — Harry Figueroa, a teacher who went a week without the oxygen that helped him breathe, died here last week at 58. His body went unrefrigerated for so long that the funeral director could not embalm his badly decomposed corpse.

Miguel Bastardo Beroa’s kidneys are failing. His physicians at the intensive care unit at Doctors Hospital in Carolina are treating him for a bacterial disease that he probably caught in floodwaters contaminated with animal urine.

José L. Cruz wakes up in the middle of the night three times a week to secure a spot in line for dialysis. His treatment hours have been cut back to save fuel for the generators that power the center.

“Because of the electricity situation, a lot of people died, and are still dying,” said Mr. Figueroa’s daughter, Lisandra, 30. “You can’t get sick now.”

Nearly three weeks after Hurricane Maria tore through Puerto Rico, many sick people across the island remain in mortal peril. The government’s announcements each morning about the recovery effort are often upbeat, but beyond them are hidden emergencies.

Seriously ill dialysis patients across Puerto Rico have seen their treatment hours reduced by 25 percent because the centers still lack a steady supply of diesel to run their generators. Less than half of Puerto Rico’s medical employees have reported to work in the weeks since the storm, federal health officials said.

Hospitals are running low on medicine and high on patients, as they take in the infirm from medical centers where generators failed. A hospital in Humacao had to evacuate 29 patients last Wednesday — including seven in the intensive care unit and a few on the operating table — to an American military medical ship off the coast of Puerto Rico when a generator broke down.

There are urgent attempts to help. The federal government has sent 10 Disaster Medical Assistance Teams of civilian doctors, nurses, paramedics and others to the island. Four mobile hospitals have been set up in hospital parking lots, and the Comfort, a medical treatment ship, is on the scene. A 44-bed hospital will soon open in badly wrecked Humacao, in the southeast.

But even as the Army Corps of Engineers is installing dozens of generators at medical facilities, and utility crews work to restore power to 36 hospitals, medical workers and patients say that an intense medical crisis persists and that communications and electrical difficulties have obscured the true number of fatalities directly related to the hurricane. The official count rose on Tuesday to 43.

Matching resources with needs remains a problem. The Puerto Rico Department of Health has sent just 82 patients to the Comfort over the past six days, even though the ship can serve 250. The Comfort’s 800 medical personnel were treating just seven patients on Monday.

The mayor of Canóvanas, in the northeast part of the island, reported over the weekend that several people in her city had died of leptospirosis, the bacterial disease Mr. Bastardo is believed to have caught from the floodwaters.

The Puerto Rico Department of Health said Sunday night that several cases were being evaluated, but that lab tests had not yet come back to confirm the diagnosis. At the same time, the agency urged people to drink only bottled water and to wear protective shoes near bodies of water that could be contaminated with animal urine.

According to status.pr, as of October 10 16% of the island has electricity; 70 hospitals are operating, but only 25 have electricity; and 46 dialysis centers are in operating, as of October 6.

The destruction left in Puerto Rico in the path of Hurricane María has pushed the condition of the island back several decades, including when the authorities work to assess the magnitude of the damage, a delegate of the territory has said.

"The devastation of Puerto Rico has put us back about 20-30 years. ... I can't deny that this is a different Puerto Rico from what we saw a week ago," said Jenniffer González, Resident Commissioner of Puerto Rico. "The devastation of property, the collapsed buildings, homeless families, ruins everywhere. The greenery of the island is gone," she added.

Engineers were planning on Sunday to inspect the 90-year-old Guajataca dam, whose reservoir covers 5 square kilometers (2 squar miles) in the northwest of Puerto Rico. The government has report the dam has an enormous crack since María dumped almost 15 inches of rain in the surrounding mountains. They pointed out that "it can collapse at any moment." Residents of the area were evacuated, but began to return to their homes on Sunday after a spillway was opened to relieve pressure on the dam.

Long after the mainland media have lost interest in the disaster, some of the worst consequences will emerge, and many of them will be in the public-health sector.

We can expect a spate of waterborne diseases: leptospirosis, skin infections, diarrhea, hepatitis A and E, typhoid, and maybe even cholera. Add to that untold swarms of mosquitoes, some carrying malaria, dengue, Zika, and chikungunya. As well, mental health issues will slow Puerto Rico's recovery as thousands struggle with PTSD, depression, and anxiety.

The healthcare system will struggle just to deal with such problems, never mind control or eliminate them.

So far, the US government has shown much more concern about uppity black millionaire athletes than about the fate of 3.5 million people living (barely) on American soil.

In the aftermath of Hurricane Irma, the most immediate risks in the affected areas of the Caribbean are increased transmission of diarrhoeal diseases related to lack of access to safe drinking water and acute respiratory infection in children accommodated in overcrowded shelters. The risk of an upsurge in cholera cases in areas with previous transmission and flood-specific risks (e.g. tetanus and leptospirosis) should be given priority when adopting mitigating measures. Mosquito-borne diseases represent a delayed risk that should be taken into account in this context.

April 02, 2017

Flooding and mudslides in the Colombian city of Mocoa sent torrents of water and debris crashing onto houses in the early hours of Saturday morning, killing 254 people, injuring hundreds and sending terrified residents, some in their pyjamas, scrambling to evacuate.

Heavy rains caused several rivers to overflow, pushing sediment and rocks on to buildings and roads in the capital of southwestern Putumayo province and immobilising cars in several feet of mud.

“It was a torrential rainstorm, it got really strong between 11pm and 1am,” said local resident Mario Usale, 42, who was looking for his father-in-law in the debris. “My mother-in-law was also missing, but we found her alive two kilometers away. She has head injuries, but she was conscious.”

Colombian President Juan Manuel Santos flew to Mocoa, population 345,000, to oversee rescue efforts on the city outskirts and speak with affected families. “We will do everything possible to help them,” Santos said after confirming the death toll. “It breaks my heart.”

The army said in a statement that 254 people were killed, 400 people had been injured and 200 were missing. More than 1,100 soldiers and police officers were called in to help dig people out in 17 affected neighborhoods.

Even in a country where heavy rains, a mountainous landscape and informal construction of homes combine to make mud and landslides a common occurrence, the scale of the Mocoa disaster was daunting compared to recent tragedies, such as a 2015 landslide that killed nearly 80 people in Salgar, Antioquia.

Colombia’s deadliest landslide, the 1985 Armero disaster, left more than 20,000 dead. “It’s a big area,” Mocoa mayor José Antonio Castro, who lost his house, told Caracol radio on Saturday. “A big portion of the many houses were just taken by the avalanche.”

He said people were warned ahead of time and many were able to get out, but several streets and two bridges had been destroyed.

Weather authorities said light rains were expected in the area on Saturday night and Sunday.

Photos posted on Twitter by the air force showed streets filled with mud and damaged houses, while videos on social media showed residents searching for survivors in the debris and struggling to move through waist-high water during the night.

Recovery will likely be complicated by diseases like diarrhea and leptospirosis, not to mention mosquito-borne dengue, Zika, and chikungunya.

April 01, 2017

Peru needs more international aid to help hundreds of thousands of people cope with continuing floods and mudslides that have killed more than 100 people and torn apart much of the country's infrastructure, the transportation minister said Friday.

Minister Martin Vizcarra told Reuters that the government will likely award reconstruction contracts in August or September, once heavy rains and the current crisis have subsided.

February 15, 2017

The rare disease goes by many names. Mud fever, sewerman’s flu, swamp fever — those are just a few of the monikers for the illness caused by the bacterium Leptospira.

As the names indicate, the disease is associated with filth, and in the developed world, it is exceedingly rare. But in the Grand Concourse neighborhood of the Bronx, where the conditions in some of the buildings have long been called unlivable by residents, the disease found its way into the vast rat population and has now been linked to a cluster of infections that have left one resident dead and two others severely ill.

The authorities ordered people living in eight illegal apartments in a subcellar at 750 Grand Concourse, one of the buildings where the infections occurred, to vacate the premises, and they have stepped up efforts to combat the rat population through extermination and better garbage management.

“I want to make clear that this is a very rare infection,” Dr. Mary Bassett, the commissioner of the New York City Department of Health and Mental Hygiene, said on Wednesday, calling the flare-up of leptospirosis cases a “cluster” on this one Bronx block, rather than an outbreak or an epidemic. “Since 2006, we’ve seen some 26 cases in New York City. The last data we have for the country as a whole suggests in 2015 there were fewer than 30 cases diagnosed across the whole country.”

The disease is caused by exposure to an infected animal’s urine, Dr. Bassett explained, not through bites or by touch or by watching a rat scurry across subway tracks. She urged anyone in the area with flulike symptoms to seek medical help. The disease can be treated with antibiotics.

The collapse of a bridge cut off the only link between the capital, Port-au-Prince, and the southern part of the country, and officials admitted it would be difficult to reach the region.

Laura Sewel, an aid worker with Care Haiti, said: "The mobile network has also gone down. So what this means for us is that we're out of contact with our staff right now which is quite difficult and the bridge going down means it will be harder to move materials."

In the port town of Les Cayes, the situation was "catastrophic", with streets flooded and many houses without roofs, deputy mayor Marie Claudette Regis Delerme said. She herself had to flee a meeting when a gust ripped off the building's roof.

Images showed people walking in shoulder-high water, with relief workers saying that other coastal communities were also under water, including Les Anglais.

While cholera and diarrhea are almost certain under these circumstances, we should also expect leptospirosis. And a very short attention span from affluent countries that will pledge a lot of aid but deliver very little.

May 19, 2016

Rats haunt the slums of Pau da Lima. Their paw prints surround drain pipes. Burrows pock dirt walls. Shriveled black feces speckle patio edges. The rodents even leave their mark in the blood of the people living here in a crowded favela on the edge of this sprawling coastal city, Brazil’s third largest. Many residents carry antibodies for Leptospira, a bacterium found in rat urine that can be deadly to humans.

“There’s so many rats. You can’t believe it. Outside, inside,” says Carlos Bautista as he sits on the step of his brick shack, looking out over a pile of sodden trash and a makeshift chicken coop.

The haunting is deeply personal for Bautista. Six years ago, his 22-year-old wife died, unexpectedly, from lung damage caused by leptospirosis. Soon after, Bautista sent his son to live in the countryside with his grandparents. “It’s better to have him alive there than to have him here” exposed to rats and disease, he says in a voice barely above a whisper.

Rats have long been one of the world’s most ubiquitous—and infamous—forms of urban wildlife, synonymous with pestilence and squalor. They’ve attracted only sporadic attention from scientists, however. Much about the secretive city rat—chiefly the Norway rat, Rattus norvegicus—remains a mystery.

But as the world’s urban population surges and more people crowd into rat-plagued neighborhoods like Pau da Lima, the rodents are getting renewed attention from researchers and public health experts. Over the past decade, scientists in a number of cities have launched efforts to better understand rat behavior and evolution, and the role they play in spreading disease.

One of the most intensive and longest-running investigations into rat-human interactions is occurring here in Pau da Lima, a chaotic jumble of buildings astride a small, hilly swathe of this city of 2.9 million people. For the last 2 decades, researchers have scrutinized the bodies, homes, and habits of favela residents—rat and human alike—while dodging encounters with gun-toting gangs.

The goal is to decipher the forces driving leptospirosis, which kills some 60,000 people annually worldwide, and find the best ways to curb a disease that experts warn is an underappreciated threat in the burgeoning slums of a more urban world.

“When we think about the slums in Jakarta or Manila or Cali, Colombia, what you see in Pau da Lima is exactly what you see in those areas, if not worse,” says Albert Ko, a physician and infectious disease expert at Yale University, and a founder of the Salvador research project. “We need to find out what solutions can be done immediately that are also generalizable to many of the urban slums.”

Ko's interest in Pau da Lima’s rats dates back to 1996, when a surge of deathly ill people, many with failing kidneys, started appearing at the Salvador hospital where he worked. At the time, leptospirosis was considered a rural disease. The corkscrew-shaped spirochete that causes it dwells in the kidneys and urinary tracts of rats and farm animals, and it infects people when their skin or mucus membranes come in contact with water contaminated by the animals’ urine. Many people show no sign of infection, or just fever and aches. But a small fraction develop severe kidney damage or massive bleeding in the lungs, although researchers aren’t sure why.

Alarmed, Ko and Brazilian colleagues spent much of a year tracking the outbreak. The results, spelled out in a 1999 article in The Lancet, were among the first alerting the world that this infection had moved to cities. Over 8 months, they found 326 severe cases, with 50 people dead, and traced the cause to a strain of Leptospira found primarily in rats. They noticed that infections surged after intense rains, and that most of the sick came from favelas on the city’s outskirts, nearly half of which had open sewers. One was Pau da Lima.

March 03, 2016

People are being advised to take necessary precautions as there are some suspected cases of typhoid and leptospirosis.

Health Minister Jone Usamate who went to Ra, Koro Island and Tailevu North, says the Ministry's major focus is to ensure that people have safe and clean water and proper sanitation.

He urges people to follow simple rules of washing their hands before preparing meals and eating, and boiling water and using water purification tablets if they feel the water is not safe. People are also advised to wear proper footwear while involved in outdoor activities.

Usamate says although the health facilities are badly damaged in the cyclone, the services are being provided as they have set up tents.

September 21, 2015

A South African prison where Nelson Mandela was incarcerated is being evacuated after two people died from a disease caused by exposure to rat urine.

Over 4,000 inmates are in the process of being moved from Pollsmoor to nearby prisons to avoid more infections.

The two inmates of the Cape Town prison died in August, reports SABC News.

The leptospirosis bacteria is spread from urine from rats or dogs and symptoms include fever and jaundice.

An inspection by the the National Institute For Communicable Diseases showed overcrowding and blocked drains meant inmates were exposed to infected rat urine.

The Police and Prisons Civil Rights Union expressed their concern on Sunday that the prison appeared to be at 300% capacity.

It is extremely rare for a South African prison to be evacuated, reports the BBC's Milton Nkosi from Johannesburg.

Mandela was transferred to Pollsmoor Prison in 1982, after spending 18 years on Robben Island.

The leader of the fight against white minority rule in South Africa spent six years in Pollsmoor, before he was eventually freed in 1990, going on to become the country's first black president in 1994.